Stroke Know the signs
 
     
 

Carotid Endarterectomy

  
 
 
 

Severe narrowing (or stenosis) of the carotid artery (70-99%) is an important cause of stroke. Patients with severe stenosis of an internal carotid artery are at an increased risk for stroke, and therefore surgical treatment is usually recommended.

Carotid endarterectomy (CEA) is an operation performed for patients with ischaemic strokes in which the artery is opened up and the atheromatous plaque is surgically removed. This leaves a clean and adequate arterial lumen with reduced risk of future embolic stroke or occlusion. Surgical removal of the material from the inside of the carotid artery does reduce the risk of stroke, but carries a risk of operative complications. The operation can be performed safely under local anaesthesia and protects against the risk of future stroke. It is a preventive procedure.

The North American Symptomatic Carotid Endarterectomy Trial (NASCET), and the European Carotid Surgery Trial (ECST) reported on the benefits of CAE. The key results have been summarized as follows.

 
 
 
 
  • For patients with severe stenosis (ECST > 80% = NASCET > 70%), surgery reduced the relative risk of disabling stroke or death by 48% (95% confidence interval [CI] 27 - 73%).
  • The number of patients needed to be operated on (number needed to treat [NNT]) to prevent one disabling stroke or death over 2 to 6 years follow-up was 15 (95% CI 10 - 31).
  • For patients with less severe stenosis (ECST 70 - 79% = NASCET 50 - 69%), surgery reduced the relative risk of disabling stroke or death by 27% (95% CI 15 - 44%).
  • The number of patients needed to be operated on to prevent one disabling stroke or death was 21 (95% CI 11 - 125).
 
 
 
 

Carotid occlusion at different levels- a pictorial essay

  
 
 
 
 
 

Must read Essays

  
 
  1. ECST reports
  2. NASCET reports
  
 
  • Anonymous. Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. Stroke 1991;22(6):816-7
  
 
 
 
  • Anonymous. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998;351(9113):1379-87
 
 

 

 

 

 




 

  
   
     
 
Created by B I Ogungbo in September 2002. Modified January 2008. ©